Nebulization of monoclonal antibodies for treating pulmonary diseases

ABSTRACT

The present application relates to methods and compositions employing an antibody that inhibits activation of the complement system and can be used to prevent or treat a pulmonary disease or condition.

RELATED APPLICATIONS

This application is a continuation-in-part application of U.S. patentapplication Ser. No. 10/655,861, filed Sep. 5, 2003, which claimspriority to and benefit of the filing date of U.S. ProvisionalApplication Ser. No. 60/469,189, filed May 9, 2003 and U.S. ProvisionalApplication Ser. No. 60/408,571, filed Sep. 6, 2002, all of which areincorporated by reference in their entirety.

BACKGROUND

Asthma, bronchitis and emphysema are known collectively as ChronicObstructive Pulmonary Diseases. These diseases are characterized asgeneralized airways obstruction, especially of small airways, associatedwith varying degrees of symptoms of chronic bronchitis, asthma, andemphysema. These diseases may often coexist in an individual, and it maybe difficult to determine the primary cause of an airway obstruction.Airway obstruction is defined as an increased resistance to airflowduring forced expiration. Obstruction of large airways may also occur inthese diseases, particularly in asthma. Currently available therapy forasthma remains problematic. Similarly, improved therapy is alsodesirable for treating or preventing other pulmonary diseases, forexample lung cancers.

Effective delivery to a patient is a critical aspect of any successfuldrug therapy. Various routes of delivery exist, and each has its ownadvantages and disadvantages. Oral drug delivery of pills, capsules,elixirs, and the like is perhaps the most convenient method, but manydrugs are degraded in the digestive tract before they can be absorbed.Subcutaneous injection is frequently an effective route for systemicdrug delivery, including the delivery of proteins, but enjoys a lowpatient acceptance. Since injection of drugs one or more times a day canfrequently be a source of poor patient compliance, a variety ofalternative routes of administration have also been developed, includingtransdermal, intranasal, intrarectal, intravaginal, and pulmonarydelivery. Thus, it is desirable to improve drug delivery methods andcompositions, particularly for antibody-based therapeutics in treatingor preventing pulmonary diseases.

SUMMARY

Accordingly, this application provides compositions and methods suitablefor delivering antibody-based therapeutics. These antibody-basedtherapeutics can be particularly useful in preventing or treatingpulmonary diseases or conditions such as for example asthma. Examples ofantibodies useful in this application include anti-C5 antibody orantibodies that inhibit activation of the complement cascade, forexample, the antibodies as described in U.S. Pat. No. 6,355,245. Inaddition to antibodies, other therapeutics are also contemplated to beemployed with the compositions and methods of the present application,for example, the chimeric complement inhibitor proteins as described inU.S. Pat. No. 5,627,264. Certain preferred embodiments employpexelizumab or eculizumab as the antibody therapeutic. In certainembodiments, the methods suitable for delivering antibody-basedtherapeutics for treating or preventing pulmonary diseases are notdesigned for systemic delivery of the therapeutics, and therefore,systemic effect of the therapeutics may not be observed using thesemethods.

A first aspect of the application provides a method for preventing ortreating a pulmonary disease or condition in a subject comprisingadministering to the subject a therapeutically effective amount of anantibody that inhibits activation of the complement cascade or blocksthe function of one or more subsequently activated components of thecomplement system. In certain embodiments, an additional active agent isalso administered to the same subject. Administration of the antibodyand the additional active agent may occur simultaneously or sequentiallyin either order. In certain embodiments, the antibody and the additionalactive agent can be administered to the subject via the same deliverymethod or route, for example, by inhalation. In alternative embodiments,the antibody and the additional active agent can be administered to thesubject via different delivery methods or routes, for example, theantibody delivered by inhalation and the additional active agent byinjection or by oral intake.

A second aspect of the application provides an aerosol compositioncomprising an antibody that inhibits activation of the complementcascade, wherein the composition is suitable for preventing or treatinga pulmonary disease or condition in a subject. The antibody isformulated in a composition suitable for aerosolization. The antibodymay be formulated in combination with an additional active agent, andthe combination formulation is suitable for aerosolization.Alternatively, the antibody and an additional active agent may beformulated separately, such that they will be combined afteraerosolization occurs or after being administered to a subject.

A third aspect of the application provides a nebulization compositioncomprising an antibody that inhibits activation of the complementcascade, wherein the composition is suitable for preventing or treatinga pulmonary disease or condition in a subject. The antibody isformulated in a composition suitable for nebulization. Similarly, theantibody may be formulated in combination with an additional activeagent, and the combination formulation is suitable for nebulization.Alternatively, the antibody and an additional active agent may beformulated separately, such that they will be combined afternebulization occurs or after being administered to a subject.

A further aspect of the application provides a biopharmaceutical packagecomprising an antibody that inhibits activation of the complementcascade and a nebulizer, wherein the package is suitable for preventingor treating a pulmonary disease or condition in a subject. Thebiopharmaceutical package may further comprise an active agent inaddition to the antibody. The biopharmaceutical package may alsocomprise instructions for use.

Pulmonary diseases or conditions contemplated by the applicationinclude, but are not limited to, asthma, bronchial constriction,bronchitis, a chronic obstructive pulmonary disease (COPD), interstitiallung diseases, lung malignancies, α-1 anti-trypsin deficiency,emphysema, bronchiectasis, bronchiolitis obliterans, sarcoidosis,pulmonary fibrosis, and collagen vascular disorders.

The timing of administering a therapeutic to a subject can vary, forexample, depending on the identity of the subject or the pulmonarydisease or condition to be treated or prevented, or both. For example,the administration may occur before the manifestation of the pulmonarycondition (e.g., pre-asthmatic attack), during the manifestation of thepulmonary condition (e.g., during the asthmatic attack), or after themanifestation of the pulmonary condition (e.g., post-asthmatic attack).

An antibody of the present application can be specific to C5 such thatit prevents the cleavage of C5 into C5a and C5b. The antibody can bespecific to the C5 convertase. Alternatively, the antibody may bespecific to a component of the complement system, for example, C5a, C5b,or C5b-9, and the antibody specific to the component preferably inhibitsthe component's function, for example, by blocking the component'sbinding to its respective receptor, or by blocking its function inactivating the subsequent signaling or events in the complement cascade.Certain embodiments employ eculizumab or pexelizumab, or both. Anantibody or antibody therapeutic of the present application can be afull length immunoglobulin, a monoclonal antibody, a chimeric antibody(e.g., a humanized antibody), a single chain antibody, a domainantibody, an Fab fragment, or an antibody having an Fab fragment and amutated Fc portion. In certain embodiments, the mutated Fc portion doesnot activate complement, or the mutation(s) in the Fc portion decreasesthe Fc portion's ability to activate complement. An antibody of thepresent application may be produced or processed in bulk and packaged inan ampule made of a suitable material (e.g., glass or plastic) atdifferent doses.

An additional active agent (or an active agent in addition to theantibody therapeutic) of the present application can be another antibodytherapeutic (e.g., an anti-IgE antibody such as Xolair® or omalizumab,an anti-IL-4 antibody or an anti-IL-5 antibody), an anti-IgE inhibitor(e.g., Singulair® or montelukast sodium), a sympathomimetic (e.g.,albuterol), an antibiotic (e.g., tobramycin), a deoxyribonuclease (e.g.,pulmozyme), an anticholinergic drug (e.g., ipratropium bromide), acorticosteroid (e.g., dexamethasone), a β-adrenoreceptor agonist, aleukotriene inhibitor (e.g., zileuton), a 5 Lipoxygenase inhibitor, aPDE inhibitor, a CD23 antagonist, an IL-13 antagonist, a cytokinerelease inhibitor, a histamine H1 receptor antagonist, ananti-histamine, an anti-inflammatory agent (e.g. cromolyn sodium) or ahistamine release inhibitor.

An example of formulation suitable for aerosolization or nebulization ofan antibody is in physiologic osmolarity (e.g., between 280 and 320 mM)at a suitable pH (e.g., pH 6 to 8). A formulation of the presentapplication may further comprise an excipient, for example polysorbate80 which can be used at 0.0015 to 0.02%.

A nebulizer of the present application can be a jet air nebulizer (e.g.,Pari LC Jet Plus or Hudson T Up-draft II), an ultrasonic nebulizer(e.g., MABISMist II), a vibrating mesh nebulizer (e.g., Micro air byOmron) and a shockwave nebulizer (EvitLabs Sonik LDI20).

BRIEF DESCRIPTION OF THE DRAWINGS

The patent or application file contains at least one drawing executed incolor. Copies of this patent or patent application publication withcolor drawing(s) will be provided by the Office upon request and paymentof the necessary fee.

FIG. 1 illustrates blocking the generation of C5a and C5b-9 by anti-C5mAb, BB5.1. Pharmacodynamic profile (A) of inhibition of C5b-9 mediatedhemolysis from animals given a single i.v. or i.p. injection of anti-C5mAb (40 mg/kg) or control mAb (40 mg/kg). ● represents data from 4control animals that were given control mAb by either i.v. (n=2) or i.p.(n=2). ▴ represents i.p. anti-C5 mAb-treated animals (n=3). A representsi.v. anti-C5 mAb-treated animals (n=3). C5a-mediated neutrophilmigration (B) was analyzed in an in vitro assay. Zymosan activated sera(20%) was used as the source of C5a. Anti-C5 mAb (100 μg/ml) was addedto serum sample prior to zymosan activation as indicated (n=8). *indicates p<0.05 when compared to zymosan activated serum samples.BALB/c mice were used in all figures except FIGS. 4 C and D.

FIG. 2 shows airway response to OVA provocation and definition of threecritical checkpoints. A: Representative DCP results indicating thelongitudinal changes of sRaw. After aerosol challenge with 5% OVA for 10min, the appearance of EAR was observed at 15 min, followed by the LARat 5 h. B: Three critical points during the course of disease.Checkpoint 1: Anti-C5 mAb was given by i.p. injection on days 25, 29 and31. Analysis of lower airway functions and quantification of airwayinflammation were evaluated 5 h after aerosol challenge of 5% OVA on day32. Checkpoint 2: Anti-C5 mAb was given by i.p. injection on day 33,after recovery from the first airway response on day 32. AHR wasassessed by evaluating the changes of RL and Cdyn from baseline inresponse to aerosol Mch challenge on day 35. Checkpoint 3: C5 inhibitionwas given by either i.v. or aerosol administration of BB5.1 during EARon day 35. Lower airway function was determined during the peak of LAR,5 h after 5% OVA provocation.

FIG. 3 shows contribution of C5 at checkpoint 1, the initiation ofairway inflammation. Mean serum OVA-specific antibody titers of 5-6 miceon day 32 were measured by ELISA (A). Cross hatched bars: OVA-specificIgG. Open bars: OVA-specific IgE. Also on day 32, animals were tracheacannulated for the measurement of RL (B) and Cdyn (C) 5 h after 5%aerosol OVA provocation, followed by histological analyses of lung (D).The mean histology score for control mAb-treated mice (F) is 2±0.28compared to 0.64±0.21 for corticosteroid-treated animals (G) and1.25±0.25 for anti-C5 mAb-treated animals (H) compared to total lack ofinflammation, score=0, seen in sham-mice (E). * indicates p<0.05 whencomparing treated animals (i.e. corticosteroid or anti-C5 mAb treatment)with control mAb treated animals, while ▪ indicates p<0.05 whencomparing corticosteroid treated mice with animals treated with antibodytargeting C5 or C5aR in this and all following figures unless otherwiseindicated. For clarity, all control mAb treated animals are labeled ascontrol in all following figures. Arrow indicates eosinophilinfiltration. Giemsa stain, magnification=100×.

FIG. 4 shows contribution of C5 at checkpoint 2, the development of AHR.C5s BALB/cByJ mice (A&B) and C5d B10D2oSn mice (C&D) were immunized withOVA in identical manner (FIG. 2 B). Animals were randomized and given(i.p.) the indicated treatment on day 33. On day 35, aerosol Mchchallenges were administered through a trachea cannula duringmeasurement of RL (A&C) and Cdyn (B&D). Changes in RL and Cdyn areexpressed as a percentage of baseline after each aerosol challenge.Subgroups of C5d mice with or without OVA immunization werereconstituted (i.v.) with 200 μg of rmC5a 3 hours prior to Mchchallenges. For C5s BALB/c mice, * indicates p<0.05 when comparingeither steroid or anti-C5 mAb treated animals with control mAb treatedanimals. For C5d B10D2oSn mice, * indicates p<0.05 when comparing themAb treated animals (n=6) given either control mAb (n=3) or anti-C5 mAb(n=3) with OVA immunized C5d B10D2oSn mice reconstituted with rmC5a.There are no statistical differences between C5d animals treated withcontrol mAb and anti-C5 mAb.

FIG. 5 shows contribution of C5 at checkpoint 3, during an on-goingairway response. Animals that experienced previous airway response toallergen provocation on day 32 were given a second aerosol allergenchallenge on day 35. During the peak of EAR, animals were randomized andgiven (i.v.) the indicated treatment. Animals were trachea cannulatedfor the measurement of RL (A) and Cdyn (B) 5 h after the OVAprovocation. (n=7-8 mice per group.)

FIG. 6 shows BALF WBC counts and differential analysis. BALF wasobtained 5 h after aerosol allergen provocation at checkpoint 1 (A) orat checkpoint 3 (B&C). Total BALF WBC counts (A&B) and theirdifferential analyses (C) were performed by a pathologist in a doubleblind fashion. For 6 (C), open bars: alveolar macrophages. Cross hatchedbars: Eosinophils. Solid bars: Neutrophils. Hatched bars: Lymphocytes.(n=6-8 mice per group.)

FIG. 7 shows BALF levels of inflammatory mediators. BALF was obtained 5h after aerosol allergen provocation at checkpoint 1 (cross hatchedbars) or checkpoint 3 (solid bars). BALF levels of IL-5 (A), IL-13 (B),histamine (C), eotaxin (D), RANTES (E), activated TGF-β (F), TNF-α (G)and proMMP9 (H) were measured by ELISA. (n=6-8 samples per group.)

FIG. 8 shows contribution of intrapulmonary C5 activation at checkpoint3. Results represent data pooled from 3 separate experiments withidentical experimental procedures. Animals were aerosol challenged with5% OVA and randomized. During EAR, animals were then given aerosoladministration of one of the indicated treatments through a jetnebulizer. Sham-immunized mice were treated with aerosol PBS. Allanimals were trachea cannulated for the measurement of RL (A) and Cdyn(B) 5 h after the OVA provocation. BALF WBC counts (C) and proMMP9 (D)were analyzed in the majority of animals. The data from control mAb(n=15) and control sIgG treated mice (n=4) were pooled together. Exceptanti-C5 Fab (n=3), n=6-19 animals in all other cohorts.

FIG. 9 shows the result of combined therapy on the development of AHR insubjects with established airway inflammation. The results were obtainedbased on checkpoint 2 study as described herein. Treatment was deliveredon day 32 by nebulization instead of i.p. Mch challenge occurred on day35. For anti-C5, BB5.1 at 3 mg/ml was subjected to nebulization for 10minutes. The steroid at 2 mg/ml was nebulized for 10 minutes. For thecombination, the final concentration was 3 mg/ml for BB5.1 and 2 mg/mlfor the steroid, which was subjected to nebulization for 10 minutes.

FIG. 10 shows exemplary formulations suitable for nebulization of anantibody.

FIG. 11 shows the result of Mch challenge two days after nebulizationtreatment.

FIG. 12 shows the particle size distribution.

FIG. 13 shows nebulization and delivery efficiencies.

FIG. 14 shows SDS-PAGE analysis of aerosolized eculizumab.

FIG. 15 shows SEC HPLC analysis of aerosolized eculizumab using twodifferent nebulizers.

FIG. 16 shows that repeated long term aerosol administrations of anti-C5monoclonal antibody do not induce airway inflammation. The mice herewere subject to 10-week treatments: sham mice were treated with PBS for10 min twice per week for 10 weeks; control mice were treated withHFN7.1 (an isotype-matched mouse antibody) for 10 min by nebulization,also twice a week for 10 weeks; the anti-C5 antibody (BB5.1) treatedmice were treated with BB5.1 for 10 min by nebulization, also twice aweek for 10 weeks.

DETAILED DESCRIPTION OF THE APPLICATION

Overview

The present application abbreviates certain terms as follows:

AHR: airway hyper-responsiveness; BALF: bronchoalveolar lavage fluid;Cdyn—dynamic lung compliance; C5aR: C5a receptor; C5d: C5 deficient;C5s: C5 sufficient; DCP: double chamber plethysmograph; EAR: Early phaseairway response; IC: immune complexes; LAR: Late phase airway response;Mch: methacholine; rmC5a: recombinant mouse C5a; RL: lung resistance;sRaw: Specific airway resistance; sIgG: serum IgG.

The Complement System

The complement system acts in conjunction with other immunologicalsystems of the body to defend against intrusion of cellular and viralpathogens. There are at least 25 complement proteins, which are found asa complex collection of plasma proteins and membrane cofactors. Theplasma proteins make up about 10% of the globulins in vertebrate serum.Complement components achieve their immune defensive functions byinteracting in a series of intricate but precise enzymatic cleavage andmembrane binding events. The resulting complement cascade leads to theproduction of products with opsonic, immunoregulatory, and lyticfunctions.

The complement cascade progresses via the classical pathway or thealternative pathway. These pathways share many components, and whilethey differ in their initial steps, they converge and share the same“terminal complement” components (C5 through C9) responsible for theactivation and destruction of target cells.

The classical complement pathway is typically initiated by antibodyrecognition of and binding to an antigenic site on a target cell. Thealternative pathway is usually antibody independent, and can beinitiated by certain molecules on pathogen surfaces. Both pathwaysconverge at the point where complement component C3 is cleaved by anactive protease (which is different in each pathway) to yield C3a andC3b. Other pathways activating complement attack can act later in thesequence of events leading to various aspects of complement function.

C3a is an anaphylatoxin (see discussion below). C3b binds to bacterialand other cells, as well as to certain viruses and immune complexes, andtags them for removal from the circulation. (C3b in this role is knownas opsonin.) The opsonic function of C3b is considered to be the mostimportant anti-infective action of the complement system. Patients withgenetic lesions that block C3b function are prone to infection by abroad variety of pathogenic organisms, while patients with lesions laterin the complement cascade sequence, i.e., patients with lesions thatblock C5 functions, are found to be more prone only to Neisseriainfection, and then only somewhat more prone (Fearon, in IntensiveReview of Internal Medicine, 2d ed. Fanta and Minaker, eds. Brigham andWomen's and Beth Israel Hospitals, 1983).

C3b also forms a complex with other components unique to each pathway toform classical or alternative C5 convertase, which cleaves C5 into C5aand C5b. C3 is thus regarded as the central protein in the complementreaction sequence since it is essential to both the alternative andclassical pathways (Wurzner, et al., Complement Inflamm. 8:328-340,1991). This property of C3b is regulated by the serum protease Factor I,which acts on C3b to produce iC3b. While still functional as opsonin,iC3b cannot form an active C5 convertase.

C5 is a 190 kDa beta globulin found in normal serum at approximately 75μg/ml (0.4 μM). C5 is glycosylated, with about 1.5-3 percent of its massattributed to carbohydrate. Mature C5 is a heterodimer of a 999 aminoacid 115 kDa alpha chain that is disulfide linked to a 656 amino acid 75kDa beta chain. C5 is synthesized as a single chain precursor proteinproduct of a single copy gene (Haviland et al. J. Immunol. 1991,146:362-368). The cDNA sequence of the transcript of this gene predictsa secreted pro-C5 precursor of 1659 amino acids along with an 18 aminoacid leader sequence.

The pro-C5 precursor is cleaved after amino acid 655 and 659, to yieldthe beta chain as an amino terminal fragment and the alpha chain as acarboxyl terminal fragment, with four amino acids deleted between thetwo. C5a is cleaved from the alpha chain of C5 by either alternative orclassical C5 convertase as an amino terminal fragment comprising thefirst 74 amino acids of the alpha chain. Approximately 20 percent of the11 kDa mass of C5a is attributed to carbohydrate. The cleavage site forconvertase action is at or immediately adjacent to amino acid residue733 of the 1659-amino acid pro-C5 precursor sequence with an 18-aminoacid leader sequence (SEQ ID NO:2 as described in U.S. Pat. No.6,355,245). A compound that would bind at or adjacent to this cleavagesite would have the potential to block access of the C5 convertaseenzymes to the cleavage site and thereby act as a complement inhibitor.

C5 can also be activated by means other than C5 convertase activity.Limited trypsin digestion (Minta and Man, J. Immunol. 1977,119:1597-1602; Wetsel and Kolb, J. Immunol. 1982, 128:2209-2216) andacid treatment (Yamamoto and Gewurz, J. Immunol. 1978, 120: 2008;Damerau et al., Molec. Immunol. 1989, 26:1133-1142) can also cleave C5and produce active C5b.

C5a is another anaphylatoxin. C5b combines with C6, C7, and C8 to formthe C5b-8 complex at the surface of the target cell. Upon binding ofseveral C9 molecules, the membrane attack complex (MAC, C5b-9, terminalcomplement complex—TCC) is formed. When sufficient numbers of MACsinsert into target cell membranes the openings they create (MAC pores)mediate rapid osmotic lysis of the target cells. Lower, non-lyticconcentrations of MACs can produce other effects. In particular,membrane insertion of small numbers of the C5b-9 complexes intoendothelial cells and platelets can cause deleterious cell activation.In some cases activation may precede cell lysis.

As mentioned above, C3a and C5a are anaphylatoxins. These activatedcomplement components can trigger mast cell degranulation, whichreleases histamine and other mediators of inflammation, resulting insmooth muscle contraction, increased vascular permeability, leukocyteactivation, and other inflammatory phenomena including cellularproliferation resulting in hypercellularity. C5a also functions as achemotactic peptide that serves to attract pro-inflammatory granulocytesto the site of complement activation.

Pulmonary Diseases or Conditions, and the Complement System

Certain pulmonary diseases or conditions such as asthma can becharacterized by a combination of chronic airway inflammation, airwayobstruction and airway hyper-responsiveness (AHR) to various stimuli. Itis thought to be mediated primarily by adaptive immune responsesincluding allergen-specific CD4⁺ T cells, Th2 cytokines, and allergenspecific IgE leading to pulmonary inflammation and AHR. Complement andits activated components, which form a central core of innate immunedefense against bacterial, viral and fungal invasions (Nagy et al., J.Allergy. Clin. Immunol. (2003) 112:729-734; Kasamatsu et al., Arerugi(1993) 42:1616-1622; Bjornson et al., Am. Rev. Respir. Dis. (1991)143:1062-1066), can be activated through the classical pathway,alternative pathway and the lectin pathway (Lachmann, Res. Immunol.(1996) 147:69-70). All three activation pathways converge at complementcomponent C5 prior to the generation of C5a and C5b-9, both of whichinduce potent biological responses including tissue injury,inflammation, anaphylatoxic responses, and cell lysis at very lowconcentrations (Takafuji et al., Int. Arch. Allergy Immunol. (1994) 104Suppl. 1:27-29). In addition, C5 can be activated after allergenexposure (Nagata et al., J. Allergy Clin. Immunol. (1987) 80:24-32).Recent data from animal models of allergic asthma suggest that activatedcomplement components, such as C5a, provide a critical link betweeninnate and adaptive immunity (Karp et al., Nat. Immunol. (2000)1:221-226). However, controversies remain in the art regarding theinvolvement of C5 and its activated components in the pathogenesis ofasthma (Karp et al., supra; Gerard et al., Curr. Opin. Immunol. (2002)14:705-708; Abe et al., J. Immunol. (2001) 167:4651-4660; Lukacs et al.,Am. J. Physiol. Lung Cell. Mol. Physiol. (2001) 280(3):L512-L518).

Several experimental models for bronchial asthma have indicated that C5and its activated components are involved in the development of airwayinflammation and bronchoconstriction (or bronchial constriction).Inhibition studies with various complement inhibitors markedly reducedAHR or airway inflammation in rodents (Abe et al., supra; Lukacs et al.,supra). The potential involvement of C5 activation was also extended toclinical observations that the severity of clinical symptoms wascorrelated with the extent of C5 activation (Gonczi et al., Allergy(1997) 52:1110-1114). On the other hand, studies have shown that C5deficiency (C5d) leads to increased susceptibility to allergen-inducedAHR in mice, and this finding is supported by evidence of decreasedproduction of IL-12, a key Th1 cytokine reported to modulate thepathogenesis of asthma (Karp et al., supra). The key question at thecenter of the debate is whether C5 and its activated components arepro-inflammatory or anti-inflammatory during the sensitization phase andthe effector phase of the pathogenesis as suggested respectively fromstudies of C5d animals (Karp et al., supra) and experiments withintervention during the course of disease (Abe et al., supra; Lukacs etal., supra). In addition, another key issue is whetherintrapulmonary-activated complement components play a significant rolein the pathogenesis and overcome the potential anti-inflammatory effectof activated C5 components on the adaptive immune system (Karp et al.,supra).

The present application relates to the study of the contribution of C5and its activated components at three critical points during the courseof disease, which outlines the key mechanisms of this essentialcomponent of the innate immune system in the pathogenesis of asthma.Comprehensive analyses of lower airway function and quantification ofmultiple parameters of airway inflammation have been conducted. Asdescribed herein, the study shows that C5 contributes to the initiationof airway inflammation, demonstrates the critical contribution of C5 inthe development of AHR in animals with established airway inflammationand the significant role of activated C5 components in sustaining anon-going airway response to allergen challenge.

The pathophysiological hallmark necessary for the development ofasthma-like symptoms is airway inflammation. Individuals with a geneticpredisposition may have modulated adaptive immune responses toenvironmental exposures, including activation of allergen-specific CD4⁺T cells, polarization of Th2 cytokines, such as IL-4 and IL-5, which arecritically involved in the production of allergen-specific IgE and therecruitment of eosinophils (Cieslewicz et al., J. Clin. Invest. (1999)104:301-308). More recently, IL-13 was identified as a key player in thepathogenesis, and reported to be both necessary and sufficient to inducethe airway response in animals (Wills-Karp et al., Science (1998)282:2258-2261). As shown by the study described herein, the broadspectrum of anti-inflammatory activities of corticosteroid, includingmodulating the Th2 cytokine profile (FIGS. 7 A and B) and blocking therecruitment of inflammatory cells into lower airways (FIG. 3 D),correlates with its potent antiasthmatic activity. Consistent with itsanti-inflammatory activities reported earlier (Wang et al., Proc. Natl.Acad. Sci. U.S.A (1996) 93:8563-8568), C5 inhibition at checkpoint 1resulted in significantly less airway inflammation without significantimpact on the adaptive immune system's responses to allergen exposures.Further, C5d animals developed a similar degree of airway inflammationas that developed by C5s animals. One possible explanation is thatairways are directly exposed to allergens and infections. Theseexposures may activate other complement components, such as C3a, whichhas very similar proinflammatory properties (Takafuji et al., Int. Arch.Allergy Immunol. (1994) 104 Suppl. 1:27-29; Nagata et al., J. AllergyClin. Immunol. (1987) 80:24-32), and was known to contribute to thepathogenesis (Gerard et al., Curr. Opin. Immunol. (2002) 14:705-708).The data provided in the present application indicate that activated C5components are critically involved but are not necessary for theinitiation of airway inflammation, which requires the activation ofadaptive immune responses to aerosol exposures of allergen (Cieslewiczet al., supra). However, at checkpoints 2 and 3 when airway inflammationwas already well established, the data described herein indicate that C5inhibition has similar or better efficacy than corticosteroid inameliorating airway inflammation and improving lower airway functions(see, e.g., FIGS. 4-8).

The second hallmark of asthma, the development of AHR in response tonon-specific stimuli, was selected as another critical checkpoint. Bypre-screening several strains of C5s and C5d mice, the geneticinfluences on the function of muscarinic acetylcholine receptorresponsible for the intrinsic AHR (De Sanctis et al., Am. J. Respir.Crit. Care Med. (1997) 156:S82-S88; Levitt et al., FASEB J. (1988)2:2605-2608.) are eliminated from the study described herein. Usinganimals that do not have intrinsic AHR, C5 inhibition is shown to besufficient to prevent the development of AHR to aerosol Mch challengesin C5s BALB/c mice with established airway inflammation (FIGS. 4 A andB) while reconstitution of C5d B10D2oSn mice with rmC5a restored AHR,also in the presence of established airway inflammation (FIGS. 4 C andD). These data suggest that C5, most likely C5a, serves as a direct linkbetween the innate immune responses and the key components of theairways responsible for AHR. C5aR was found on airway smooth musclecells and airway epithelia (Drouin et al., J. Immunol. (2001)166:2025-2032). Although the direct interaction of activated C5components, in particular C5a, with receptors on airway smooth musclesand epithelium was demonstrated previously (Irvin et al., Am. Rev.Respir. Dis. (1986) 134:777-783; Larsen, Annu. Rev. Immunol. (1985)3:59-85.), the data provided herein indicate that the maintenance of AHRdepends upon complex interactions among airway epithelia, airway smoothmuscle cells, inflammatory cells and their inflammatory mediators assuggested by minimal impact on the functions of lower airways during Mchchallenges after systemic reconstitution (i.v.) of sham B10D2.oSn micewith rmC5a (FIGS. 4 C and D).

The on-going airway responses after aerosol allergen provocation, serveas the third critical checkpoint in the study described herein. Thedevelopment of EAR and LAR together with massive production and releaseof multiple inflammatory mediators provide a good opportunity to examinethe complex interaction of activated C5 components with other componentsof innate and adaptive immune responses and their role in pathogenesis.The data described herein demonstrate that C5 inhibition by eitheranti-C5 monoclonal antibody (mAb) or its Fab fragment achieved similarin vivo efficacy in ameliorating intrapulmonary inflammatory activitiesas well as in improving functions of lower airways.

The data here also suggest that in the presence of airway inflammation,activated C5 components function as the key regulators of the downstreaminflammatory cascade. This regulatory effect is demonstrated by itsability to influence the migration of inflammatory cells into airwaylumen as well as the activation and the release of multiple harmfulmediators corresponding to the significant changes of lower airwayfunctions at checkpoint 3. C5a is probably the most potent activator ofinflammatory cells (Takafuji et al., supra) and C5aR has been identifiedon circulating leukocytes, mast cells, macrophages, and endothelialcells (Chenoweth et al., Proc. Natl. Acad. Sci. U.S.A. (1978)75:3943-3947). The disassociation of significant improvement of lowerairway functions with significant presence of intrapulmonaryinflammatory activities after anti-C5aR sIgG treatment is consistentwith the hypothesis that the direct engagement of C5a with its receptorsexpressed on airway smooth muscle cells and epithelia is, in part,responsible for airway constriction (Irvin et al., supra). The data alsoindicate that the chemotactic activity and cell activation properties ofC5b-9 (Czermak et al., Am. J. Pathol. (1999) 154:1513-1524) areresponsible for the significant intrapulmonary inflammatory activitiesin the absence of C5aR engagement. In the presence of established airwayinflammation and IC, C5b-9 can sufficiently regulate the downstreaminflammatory cascade by triggering releases of multiple mediators suchas proMMP9 independently of the engagement of C5a with its receptorsexpressed on inflammatory cells (FIG. 8 D). The presence of an elevatedlevel of C5b-9 together with the presence of multiple inflammatorymediators contributed to migration of inflammatory cells into thebronchial lumen in animals treated with anti-C5aR sIgG (FIG. 8 C).

Both the adaptive and innate immune systems contributed in the complexprocess of the production and release of multiple inflammatorymediators, including leukotrienes, prostaglandins, histamine, alkalineproteins, cytokines, chemokines, and enzymes, which are responsible forbronchospasm, altered vascular permeability, adherence and migration ofinflammatory cells, mucosal edema and excessive mucous secretion andultimately lead to three unique but interdependent phenomena: airwayinflammation, airway obstruction and AHR. Since there are many redundantbiological mechanisms, under the right circumstances, such as ingenetically deficient animals, these redundant mechanisms may compensateand contribute in a more significant fashion. The complex relationshipand interactions of these components are responsible for airwayinflammation, obstruction and AHR, as well as other pulmonary diseasesor conditions.

Lung parenchymal cells possess the ability to produce C5 and cleave C5into activated fragments (Desai et al, J. Exp. Pathol. (1984)1:201-216). The activation of C5 as part of innate immune responses maywell be an innocuous by-product of a self-defensive response, due inpart to direct enzymatic cleavage of C5 (Maruo et al, J. Allergy Clin.Immunol. (1997) 100:253-260) after exposure to allergens (Nagata et al.,supra), house dust (Maruo et al., supra), smoke (Robbins et al., Am. J.Physiol. (1991) 260:L254-L259.) or airway infections (Nagy et al., J.Allergy. Clin. Immunol. (2003) 112:729-734; Kasamatsu et al., Arerugi(1993) 42:1616-1622; Bjornson et al., Am. Rev. Respir. Dis. (1991)143:1062-1066). The formation of intrapulmonary IC after allergenexposure may also activate complement cascade (Larsen, supra). Thishypothesis proposes that activated C5 components are primarily locatedat the epithelial side of the airway and, in non-asthmatic individuals,the intrapulmonary activation of complement is well regulated (Varsanoet al., Thorax (2000) 55:364-369). Consistent with this hypothesis, ourdata demonstrated that intrapulmonary C5 inhibition achieved similarefficacy as systemic C5 inhibition at checkpoint 3 (FIG. 8) and atcheckpoint 2. These data further suggest that intrapulmonary activatedC5 components are major pro-inflammatory rather than anti-inflammatoryforces.

The study also shows the effect of C5 inhibition on the inflammatorymediators produced or released by neutrophils or eosinophils (FIG. 7).These inflammatory mediators, in particular TGF-β, RANTES and proMMP9,may cause irreversible damage to airways by inducing bronchial smoothmuscle hypertrophy and deposition of collagen under the basal membranesof respiratory epithelium, which leads to the remodel and repair oflower airways, the focal point for those individuals with a poor longterm prognosis (Boulet et al., Am. J. Respir. Crit. Care Med. (2000)162:1308-1313). Accordingly, C5 inhibition, which utilizes a unique anddifferent anti-inflammatory mechanism, may complement the potentanti-inflammatory effect of corticosteroid and other active agents, andhave an added benefit for long term prognosis.

This study clearly demonstrates that the complex functional changes ofairways seen in individuals with asthma coexist with the complexinflammatory processes. On one hand, activated C5 components, such asC5a through its binding with airway C5aR, serve as the direct linkbetween the innate immune system and AHR. On the other hand, both C5aand C5b-9 regulate the downstream inflammatory cascade through theirchemotactic and cell activation activities in the presence of IC andestablished airway inflammation. Blocking the generation of C5a andC5b-9 not only improves the functioning of lower airways but alsoameliorates intrapulmonary inflammatory activities. In contrast, C5aRantagonist significantly improves functions of lower airways without adramatic impact on intrapulmonary inflammatory activities.

Aerosol or Nebulization Compositions

In one respect, this application is directed to pulmonary drug deliverycompositions and/or devices for delivering an antibody that inhibits theactivation of the complement cascade. The pulmonary drug deliverycompositions are useful for treating a pulmonary disease or condition.For example, aerosol compositions are provided for the delivery of anantibody or an antibody combined with an additional active agent to therespiratory tract. The respiratory tract includes the upper airways,including the oropharynx and larynx, followed by the lower airways,which include the trachea followed by bifurcations into the bronchi andbronchioli. The upper and lower airways are called the conductiveairways. The terminal bronchioli then divide into respiratory bronchioliwhich then lead to the ultimate respiratory zone, the alveoli, or deeplung.

Pulmonary drug delivery may be achieved by inhalation, andadministration by inhalation herein may be oral and/or nasal. Examplesof pharmaceutical devices for pulmonary delivery include metered doseinhalers (MDIs), dry powder inhalers (DPIs), and nebulizers. Exemplarydelivery systems by inhalation which can be adapted for delivery of thesubject antibody and/or active agent are described in, for example, U.S.Pat. Nos. 5,756,353; 5,858,784; and PCT applications WO98/31346;WO98/10796; WO00/27359; WO01/54664; WO02/060412. Other aerosolformulations that may be used for delivering the antibody and/or activeagent are described in U.S. Pat. Nos. 6,294,153; 6,344,194; 6,071,497,and PCT applications WO02/066078; WO02/053190; WO01/60420; WO00/66206.

Pressurized metered dose inhalers (pMDIs) are the most commonly usedinhaler worldwide. The aerosol is created when a valve is opened(usually by pressing down on the propellant canister), allowing liquidpropellant to spray out of a canister. Typically, a drug or therapeuticis contained in small particles (usually a few microns in diameter)suspended in the liquid propellant, but in some formulations the drug ortherapeutic may be dissolved in the propellant. The propellantevaporates rapidly as the aerosol leaves the device, resulting in smalldrug or therapeutic particles that are inhaled. Propellants typicallyused in such pMDIs include but are not limited to hydrofluoroalkanes(HFAs). A surfactant may also be used, for example, to formulate thedrug or therapeutic, with pMDIs. Other solvents or excipients may alsobe employed with pMDIs, such as ethanol, ascorbic acid, sodiummetabisulfate, glycerin, chlorobutanol, and cetylpyridium chloride. SuchpMDIs may further include add-on devices such as, for example, spacers,holding chambers and other modifications.

Nebulizers produce a mist of drug-containing liquid droplets forinhalation. They are usually classified into two types: ultrasonicnebulizers and jet nebulizers. A new type of nebulizer is alsoavailable, which does not require ultrasound or air pressure tofunction. Single breath atomizers have also been developed (e.g.,Respimat®), which is used to deliver a drug in a single inhalation andmay be preferred because of less contamination. Jet nebulizers are morecommon and use a source of pressurized air to blast a stream of airthrough a drug-containing water reservoir, producing droplets in acomplex process involving a viscosity-induced surface instability thatleads to nonlinear phenomena in which surface tension and dropletbreakup on baffles play a role. Ultrasonic nebulizers produce dropletsby mechanical vibration of a plate or mesh. In either type of nebulizer,the drug is usually contained in solution in the liquid in the nebulizerand so the droplets being produced contain drug in solution. However,for some formulations (e.g., Pulmicort) the drug is contained in smallparticles suspended in the water, which are then contained as particlessuspended inside the droplets being produced. Certain excipients areusually included in formulations suitable for nebulization, such assodium chloride (e.g., to maintain isotonicity), mineral acids and bases(e.g., to maintain or adjust pH), nitrogen headspace sparging,benzalkonium chloride, calcium chloride, sodium citrate, disodiumedtate, and polysorbate 80.

The third type of inhaler is the dry powder inhaler (DPI). In DPIs, theaerosol is usually a powder, contained within the device until it isinhaled. The therapeutic or drug is manufactured in powder form as smallpowder particles (usually a few millionths of a meter, or micrometers,in diameter). In many DPIs, the drug or therapeutic is mixed with muchlarger sugar particles (e.g., lactose monohydrate), that are typically50-100 micrometers in diameter. The increased aerodynamic forces on thelactose/drug agglomerates improve entrainment of the drug particles uponinhalation, in addition to allowing easier filling of small individualpowder doses. Upon inhalation, the powder is broken up into itsconstituent particles with the aid of turbulence and/or mechanicaldevices such as screens or spinning surfaces on which particleagglomerates impact, releasing the small, individual drug powderparticles into the air to be inhaled into the lung. The sugar particlesare usually intended to be left behind in the device and/or in themouth-throat.

One aspect of the application provides an aerosol composition comprisingan antibody that inhibits activation of the complement cascade, whereinthe composition is suitable for preventing or treating a pulmonarydisease or condition in a subject. An aerosol antibody composition canbe a composition comprising aerosolized antibody or a compositioncomprising an antibody in a formulation suitable for aerosolization. Theantibody may be formulated in combination with an additional activeagent, and the combination formulation is suitable for aerosolization.Alternatively, the antibody and an additional active agent may beformulated separately, such that they will be combined afteraerosolization occurs or after being administered to a subject.

Another aspect of the application provides a nebulization compositioncomprising an antibody that inhibits activation of the complementcascade, wherein the composition is suitable for preventing or treatinga pulmonary disease or condition in a subject. A nebulization antibodycomposition can be a composition comprising a nebulized antibody or acomposition comprising an antibody in a formulation suitable fornebulization. Similarly, the antibody may be formulated in combinationwith an additional active agent, and the combination formulation issuitable for nebulization. Alternatively, the antibody and an additionalactive agent may be formulated separately, such that they will becombined after nebulization occurs or after being administered to asubject.

A further aspect of the application provides a biopharmaceutical packagecomprising an antibody that inhibits activation of the complementcascade and a nebulizer, wherein the package is suitable for preventingor treating a pulmonary disease or condition in a subject. Thebiopharmaceutical package may further comprise an active agent inaddition to the antibody. The biopharmaceutical package may alsocomprise instructions for use.

An antibody of the present application can be specific to C5 such thatit prevents the cleavage of C5 into C5a and C5b. The antibody can bespecific to the C5 convertase. Alternatively, the antibody may bespecific to a component of the complement system, for example, C5a, C5b,or C5b-9, and the antibody specific to the component preferably inhibitsthe component's function, for example, by blocking the component'sbinding to its respective receptor, or by blocking its function inactivating subsequent signaling or events in the complement cascade.Certain embodiments employ eculizumab or pexelizumab, or both. Anantibody or antibody therapeutic of the present application can be afull length immunoglobulin, a chimeric antibody (e.g., a humanizedantibody), a single chain antibody, a domain antibody (e.g., a domainantibody as developed by Domantis, defined as the smallest functionalbinding units of antibodies, corresponding to the variable regions ofeither the heavy (VH) or light (VL) chains of human antibodies), an Fabfragment, or an antibody having an Fab fragment and a mutated Fcportion. In certain embodiments, the mutated Fc portion does notactivate complement, or the mutation(s) in the Fc portion decreases theFc portion's ability to activate complement. An antibody of the presentapplication may be produced or processed in bulk and packaged in anampule made of a suitable material (e.g., glass or plastic) at differentdoses. The antibody may be stable in a formulation at a concentrationranging from 1 mg/ml to 200 mg/ml.

An additional active agent (or an active agent in addition to theantibody therapeutic) of the present application can be another antibodytherapeutic (e.g., an anti-complement or anti-C5 antibody, an anti-IgEantibody such as Xolair® or omalizumab, an anti-IL-4 antibody or ananti-IL-5 antibody), an anti-IgE inhibitor (e.g., Singulair® ormontelukast sodium), a sympathomimetic (e.g., albuterol), an antibiotic(e.g., tobramycin), a deoxyribonuclease (e.g., pulmozyme), ananticholinergic drug (e.g., ipratropium bromide), a corticosteroid(e.g., dexamethasone), a β-adrenoreceptor agonist, a leukotrieneinhibitor (e.g., zileuton), a 5 Lipoxygenase inhibitor, a PDE inhibitor,a CD23 antagonist, an IL-13 antagonist, a cytokine release inhibitor, ahistamine H1 receptor antagonist, an anti-histamine, ananti-inflammatory agent (e.g. cromolyn sodium) or a histamine releaseinhibitor. As used herein, an active agent may also be referred to as atherapeutic or a drug.

An example of formulation suitable for aerosolization or nebulization ofan antibody is in physiologic osmolarity (e.g., between 280 and 320 mM)at a suitable pH (e.g., pH 6 to 8). A formulation of the presentapplication may further comprise an excipient, for example polysorbate80 which can be used at 0.0015 to 0.02%.

U.S. Pat. No. 5,474,759 discloses aerosol formulations that aresubstantially free of chlorofluorocarbons, and having particular utilityin medicinal applications. The formulations contain a propellant (suchas 1,1,1,2,3,3,3,-heptafluoropropane), a medium-chain fatty acidpropylene glycol diester, a medium-chain triglyceride, optionally asurfactant, and optionally auxiliary agents such as antioxidants,preservatives, buffers, sweeteners and taste masking agents.

Other pharmaceutically acceptable carriers may also be used in aformulation of the present application. The phrase “pharmaceuticallyacceptable” is employed herein to refer to those compounds, materials,compositions, and/or dosage forms which are, within the scope of soundmedical judgment, suitable for use in contact with the tissues of humanbeings and animals without excessive toxicity, irritation, allergicresponse, or other problem or complication, commensurate with areasonable benefit/risk ratio. The phrase “pharmaceutically acceptablecarrier” as used herein means a pharmaceutically acceptable material,composition or vehicle, such as a liquid or solid filler, diluent,excipient, solvent or encapsulating material, involved in carrying ortransporting the subject antagonists from one organ, or portion of thebody, to another organ, or portion of the body. Each carrier must be“acceptable” in the sense of being compatible with the other ingredientsof the formulation and not injurious to the patient. Some examples ofmaterials which can serve as pharmaceutically acceptable carriersinclude: (1) sugars, such as lactose, glucose and sucrose; (2) starches,such as corn starch and potato starch; (3) cellulose, and itsderivatives, such as sodium carboxymethyl cellulose, ethyl cellulose andcellulose acetate; (4) powdered tragacanth; (5) malt; (6) gelatin; (7)talc; (8) excipients, such as cocoa butter and suppository waxes; (9)oils, such as peanut oil, cottonseed oil, safflower oil, sesame oil,olive oil, corn oil and soybean oil; (10) glycols, such as propyleneglycol; (11) polyols, such as glycerin, sorbitol, mannitol andpolyethylene glycol; (12) esters, such as ethyl oleate and ethyllaurate; (13) agar; (14) buffering agents, such as magnesium hydroxideand aluminum hydroxide; (15) alginic acid; (16) pyrogen-free water; (17)isotonic saline; (18) Ringer's solution; (19) ethyl alcohol; (20)phosphate buffer solutions; and (21) other non-toxic compatiblesubstances employed in pharmaceutical formulations.

Methods of preparing these formulations or compositions include the stepof bringing into association a compound of the present application withthe carrier and, optionally, one or more accessory ingredients. Ingeneral, the formulations are prepared by uniformly and intimatelybringing into association a compound of the present application withliquid carriers, or finely divided solid carriers, or both, and then, ifnecessary, shaping the product.

A nebulizer of the present application can be a jet air nebulizer (e.g.,Pari LC Jet Plus or Hudson T Up-draft II), an ultrasonic nebulizer(e.g., MABISMist II), a vibrating mesh nebulizer (e.g., Micro air byOmron) and a shockwave nebulizer (EvitLabs Sonik LD120).

“Aerosol composition” means an antibody and/or an active agent describedherein in a form or formulation that is suitable for pulmonary delivery.The aerosol composition may be in the dry powder form, it may be asolution, suspension or slurry to be nebulized, or it may be inadmixture with a suitable low boiling point, highly volatile propellant.It is to be understood that more than one antibody and optionally otheractive agents or ingredients may be incorporated into the aerosolizedformulation or aerosol composition and that the use of the term“antibody” or “active agent” in no way excludes the use of two or moresuch antibodies or other agents or ingredients.

In certain preferred embodiments, an antibody or active agent retainsmore than 50% of its activity after nebulization, preferably more than70%. In certain preferred embodiments, an antibody or active agentretains more than 50% of its purity after nebulization, preferably morethan 70%.

Active agent formulations suitable for use in the present applicationinclude dry powders, solutions, suspensions or slurries for nebulizationand particles suspended or dissolved within a propellant. Dry powderssuitable for use in the present application include amorphous activeagents, crystalline active agents and mixtures of both amorphous andcrystalline active agents. The dry powder active agents have a particlesize selected to permit penetration into the alveoli of the lungs, thatis, preferably 10 μm mass median diameter (MMD), preferably less than7.5 μm, and most preferably less than 5 μm, and usually being in therange of 0.1 μm to 5 μm in diameter. The delivered dose efficiency (DDE)of these powders is >30%, usually >40%, preferably >50 and often >60%and the aerosol particle size distribution is about 1.0-5.0 μm massmedian aerodynamic diameter (MMAD), usually 1.5-4.5 μm MMAD andpreferably 1.5-4.0 μm MMAD. These dry powder active agents have amoisture content below about 10% by weight, usually below about 5% byweight, and preferably below about 3% by weight. Such active agentpowders are described in WO 95/24183 and WO 96/32149, which areincorporated by reference herein.

Dry powder active agent formulations are preferably prepared by spraydrying under conditions which result in a substantially amorphouspowder. Bulk active agent, usually in crystalline form, is dissolved ina physiologically acceptable aqueous buffer, typically a citrate bufferhaving a pH range from about 2 to 9. The active agent is dissolved at aconcentration from 0.01% by weight to 1% by weight, usually from 0.1% to0.2%. The solutions may then be spray dried in a conventional spraydrier available from commercial suppliers such as Niro A/S (Denmark),Buchi (Switzerland) and the like, resulting in a substantially amorphouspowder. These amorphous powders may also be prepared by lyophilization,vacuum drying, or evaporative drying of a suitable active agent solutionunder conditions to produce the amorphous structure. The amorphousactive agent formulation so produced can be ground or milled to produceparticles within the desired size range. Dry powder active agents mayalso be in a crystalline form. The crystalline dry powders may beprepared by grinding or jet milling the bulk crystalline active agent.

The active agent powders of the present application may optionally becombined with pharmaceutical carriers or excipients which are suitablefor respiratory and pulmonary administration. Such carriers may servesimply as bulking agents when it is desired to reduce the active agentconcentration in the powder which is being delivered to a patient, butmay also serve to improve the dispersability of the powder within apowder dispersion device in order to provide more efficient andreproducible delivery of the active agent and to improve handlingcharacteristics of the active agent such as flowability and consistencyto facilitate manufacturing and powder filling. Such excipients includebut are not limited to (a) carbohydrates, e.g., monosaccharides such asfructose, galactose, glucose, D-mannose, sorbose, and the like;disaccharides, such as lactose, trehalose, cellobiose, and the like;cyclodextrins, such as 2-hydroxypropyl-.beta.-cyclodextrin; andpolysaccharides, such as raffinose, maltodextrins, dextrans, and thelike; (b) amino acids, such as glycine, arginine, aspartic acid,glutamic acid, cysteine, lysine, and the like; (c) organic saltsprepared from organic acids and bases, such as sodium citrate, sodiumascorbate, magnesium gluconate, sodium gluconate, tromethaminhydrochloride, and the like; (d) peptides and proteins such asaspartame, human serum albumin, gelatin, and the like; and (e) alditols,such as mannitol, xylitol, and the like. A preferred group of carriersincludes lactose, trehalose, raffinose, maltodextrins, glycine, sodiumcitrate, human serum albumin and mannitol.

The dry powder active agent formulations may be delivered using InhaleTherapeutic Systems' dry powder inhaler as described in WO 96/09085which is incorporated herein by reference, but adapted to control theflow rate at a desirable level or within a suitable range. The drypowders may also be delivered using a metered dose inhaler as describedby Laube et al. in U.S. Pat. No. 5,320,094, which is incorporated byreference herein.

Nebulized solutions may be prepared by aerosolizing commerciallyavailable active agent formulation solutions. These solutions may bedelivered by a jet nebulizer such as the Raindrop, produced by PuritanBennett, the use of which is described by Laube et al., supra. Othermethods for delivery of solutions, suspensions of slurries are describedby Rubsamen et al, U.S. Pat. No. 5,672,581. A device that uses avibrating, piezoelectric member is described in Ivri et al., U.S. Pat.No. 5,586,550, which is incorporated by reference herein.

Propellant systems may include an active agent dissolved in a propellantor particles suspended in a propellant. Both of these types offormulations are described in Rubsamen et al., U.S. Pat. No. 5,672,581,which is incorporated herein by reference.

In certain embodiments, an aerosol or nebulization antibody compositioncan be combined with one or more other aerosol or nebulizationtreatments, such as sympathomimetics (e.g., albuterol), antibiotics(e.g., tobramycin), deoxyribonucleases (e.g., pulmozyme),anticholinergic drugs (e.g., ipratropium bromide), or corticosteroids.

In certain embodiments, an aerosol or nebulization antibody compositioncan be combined with one or more other therapies (concurrently orsequentially) administered via nebulization, inhalation, intravenous ororal routes, such as sympathomimetics (e.g., albuterol), anticholinergicdrugs (e.g., ipratropium bromide), inflammation inhibitors (e.g.,cromolyn sodium), leukotriene inhibitors (e.g., zileuton), anti-IgEinhibitors (e.g., Singulair®) or corticosteroids.

As described herein, an antibody or therapeutic may be formulated asmicroparticles. Microparticles having a diameter of between 0.5 and 10microns can penetrate the lungs, passing through most of the naturalbarriers. A diameter of less than ten microns is generally required tobypass the throat; a diameter of 0.5 microns or greater is usuallyrequired to avoid being exhaled.

In certain embodiments, the subject antibody or therapeutic isformulated in a supramolecular complex, which may have a diameter ofbetween 0.5 and 10 microns, which can be aggregated into particleshaving a diameter of between 0.5 and 10 microns.

In other embodiments, the subject antibodies or therapeutics areprovided in liposomes or supramolecular complexes appropriatelyformulated for pulmonary delivery.

(i). Polymers for forming Microparticles

In addition to the supramolecular complexes described above, a number ofother polymers can be used to form the microparticles. As used herein,the term “microparticles” includes microspheres (uniform spheres),microcapsules (having a core and an outer layer of polymer), andparticles of irregular shape.

Polymers are preferably biodegradable within the time period over whichrelease of the antibody or therapeutic is desired or relatively soonthereafter, generally in the range of one year, more typically a fewmonths, even more typically a few days to a few weeks. Biodegradationcan refer to either a breakup of the microparticle, that is,dissociation of the polymers forming the microparticles and/or of thepolymers themselves. This can occur as a result of change in pH from thecarrier in which the particles are administered to the pH at the site ofrelease, as in the case of the diketopiperazines, hydrolysis, as in thecase of poly(hydroxy acids), by diffusion of an ion such as calcium outof the microparticle, as in the case of microparticles formed by ionicbonding of a polymer such as alginate, and by enzymatic action, as inthe case of many of the polysaccharides and proteins. In some caseslinear release may be most useful, although in others a pulse release or“bulk release” may provided more effective results.

Representative synthetic materials are: diketopiperazines, poly(hydroxyacids) such as poly(lactic acid), poly(glycolic acid) and copolymersthereof, polyanhydrides, polyesters such as polyorthoesters, polyamides,polycarbonates, polyalkylenes such as polyethylene, polypropylene,poly(ethylene glycol), poly(ethylene oxide), poly(ethyleneterephthalate), poly vinyl compounds such as polyvinyl alcohols,polyvinyl ethers, polyvinyl esters, polyvinyl halides,polyvinylpyrrolidone, polyvinylacetate, and poly vinyl chloride,polystyrene, polysiloxanes, polymers of acrylic and methacrylic acidsincluding poly(methyl methacrylate), poly(ethyl methacrylate),poly(butylmethacrylate), poly(isobutyl methacrylate),poly(hexylmethacrylate), poly(isodecyl methacrylate), poly(laurylmethacrylate), poly(phenyl methacrylate), poly(methyl acrylate),poly(isopropyl acrylate), poly(isobutyl acrylate), poly(octadecylacrylate), polyurethanes and co-polymers thereof, celluloses includingalkyl cellulose, hydroxyalkyl celluloses, cellulose ethers, celluloseesters, nitro celluloses, methyl cellulose, ethyl cellulose,hydroxypropyl cellulose, hydroxy-propyl methyl cellulose, hydroxybutylmethyl cellulose, cellulose acetate, cellulose propionate, celluloseacetate butyrate, cellulose acetate phthalate, carboxylethyl cellulose,cellullose triacetate, and cellulose sulphate sodium salt, poly(buticacid), poly(valeric acid), and poly(lactide-co-caprolactone).

Natural polymers include alginate and other polysaccharides includingdextran and cellulose, collagen, albumin and other hydrophilic proteins,zein and other prolamines and hydrophobic proteins, copolymers andmixtures thereof. As used herein, chemical derivatives thereof refer tosubstitutions, additions of chemical groups, for example, alkyl,alkylene, hydroxylations, oxidations, and other modifications in theart.

Bioadhesive polymers include bioerodible hydrogels described by H. S.Sawhney, C. P. Pathak and J. A. Hubell in Macromolecules, 1993, 26,581-587, polyhyaluronic acids, casein, gelatin, glutin, polyanhydrides,polyacrylic acid, alginate, chitosan, and polyacrylates.

To further illustrate, the matrices can be formed of the polymers bysolvent evaporation, spray drying, solvent extraction and other methodsknown to those skilled in the art. Methods developed for makingmicrospheres for drug delivery are described in the literature, forexample, as described by Mathiowitz and Langer, J. Controlled Release 5,13-22 (1987); Mathiowitz, et al., Reactive Polymers 6, 275-283 (1987);and Mathiowitz, et al., J. Appl. Polymer Sci. 35, 755-774 (1988). Theselection of the method depends on the polymer selection, the size,external morphology, and crystallinity that is desired, as described,for example, by Mathiowitz, et al., Scanning Microscopy 4,329-340(1990); Mathiowitz, et al., J. Appl. Polymer Sci. 45, 125-134 (1992);and Benita, et al., J. Pharm. Sci. 73, 1721-1724 (1984).

In solvent evaporation, described for example, in Mathiowitz, et al.,(1990), Benita, and U.S. Pat. No. 4,272,398 to Jaffe, the polymer isdissolved in a volatile organic solvent. The antibody and/ortherapeutic, either in soluble form or dispersed as fine particles, isadded to the polymer solution, and the mixture is suspended in anaqueous phase that contains a surface active agent such as poly(vinylalcohol). The resulting emulsion is stirred until most of the organicsolvent evaporates, leaving solid microspheres.

In general, the polymer can be dissolved in methylene chloride. Severaldifferent polymer concentrations can be used, for example, between 0.05and 0.20 g/ml. After loading the solution with drug, the solution issuspended in 200 ml of vigorously stirring distilled water containing 1%(w/v) poly(vinyl alcohol) (Sigma Chemical Co., St. Louis, Mo.). Afterfour hours of stirring, the organic solvent will have evaporated fromthe polymer, and the resulting microspheres will be washed with waterand dried overnight in a lyophilizer.

Microspheres with different sizes (1-1000 microns, though less than 10microns for aerosol applications) and morphologies can be obtained bythis method which is useful for relatively stable polymers such aspolyesters and polystyrene. However, labile polymers such aspolyanhydrides may degrade due to exposure to water. For these polymers,hot melt encapsulation and solvent removal may be preferred.

In hot melt encapsulation, the polymer is first melted and then mixedwith the solid particles of antibodies or therapeutics, preferablysieved to appropriate size. The mixture is suspended in a non-misciblesolvent such as silicon oil and, with continuous stirring, heated to 5°C. above the melting point of the polymer. Once the emulsion isstabilized, it is cooled until the polymer particles solidify. Theresulting microspheres are washed by decantation with petroleum ether togive a free-flowing powder. Microspheres with diameters between one and1000 microns can be obtained with this method. The external surface ofspheres prepared with this technique are usually smooth and dense. Thisprocedure is useful with water labile polymers, but is limited to usewith polymers with molecular weights between 1000 and 50000.

In spray drying, the polymer is dissolved in an organic solvent such asmethylene chloride (0.04 g/ml). A known amount of antibody and/ortherapeutic is suspended (if insoluble) or co-dissolved (if soluble) inthe polymer solution. The solution or the dispersion is thenspray-dried. Microspheres ranging in diameter between one and tenmicrons can be obtained with a morphology which depends on the selectionof polymer.]

Hydrogel microspheres made of gel-type polymers such as alginate orpolyphosphazines or other dicarboxylic polymers can be prepared bydissolving the polymer in an aqueous solution, suspending the materialto be incorporated into the mixture, and extruding the polymer mixturethrough a microdroplet forming device, equipped with a nitrogen gas jet.The resulting microspheres fall into a slowly stirring, ionic hardeningbath, as described, for example, by Salib, et al., PharmazeutischeIndustrie 40-111A, 1230 (1978). The advantage of this system is theability to further modify the surface of the microspheres by coatingthem with polycationic polymers such as polylysine, after fabrication,for example, as described by Lim, et al., J. Pharm. Sci. 70, 351-354(1981). For example, in the case of alginate, a hydrogel can be formedby ionically crosslinking the alginate with calcium ions, thencrosslinking the outer surface of the microparticle with a polycationsuch as polylysine, after fabrication. The microsphere particle sizewill be controlled using various size extruders, polymer flow rates andgas flow rates.

Chitosan microspheres can be prepared by dissolving the polymer inacidic solution and crosslinking with tripolyphosphate. For example,carboxymethylcellulose (CMC) microsphere are prepared by dissolving thepolymer in an acid solution and precipitating the microspheres with leadions. Alginate/polyethyleneimine (PEI) can be prepared to reduce theamount of carboxyl groups on the alginate microcapsules.

(ii). Pharmaceutical Compositions

The microparticles can be suspended in any appropriate pharmaceuticalcarrier, such as saline, for administration to a patient. In the mostpreferred embodiment, the microparticles will be stored in dry orlyophilized form until immediately before administration. They can thenbe suspended in sufficient solution, for example an aqueous solution foradministration as an aerosol, or administered as a dry powder.

(iii). Targeted Administration

The microparticles can be delivered to specific cells or organ,especially phagocytic cells and organs. Where systemic delivery of thedrug or therapeutic is desirable, endocytosis of the microparticles bymacrophages in the lungs can be used to target the microparticles to thespleen, bone marrow, liver, lymph nodes, and other parts of the body.

The microparticles can also be targeted by attachment of ligands, suchas those described above, which specifically or non-specifically bind toparticular targets, for example, particular targets within the pulmonarysystem or associated with a pulmonary disease or condition (e.g., atarget specific for cancerous cells in the lung). Examples of suchligands also include antibodies and fragments including the variableregions, lectins, and hormones or other organic molecules havingreceptors on the surfaces of the target cells.

(iv). Storage of the Microparticles

In certain embodiments, the microparticles are stored lyophilized. Thedosage is determined by the amount of encapsulated antibodies and/ortherapeutics, the rate of release within the pulmonary system, and thepharmacokinetics of the antibodies and/or therapeutics.

(v). Delivery of Microparticles

The microparticles can be delivered using a variety of methods, rangingfrom administration directly into the nasal passages so that some of theparticles reach the pulmonary system, to the use of a powderinstillation device, to the use of a catheter or tube reaching into thepulmonary tract. As described above, dry powder inhalers arecommercially available, although those using hydrocarbon propellants areno longer used and those relying on the intake of a breath by a patientcan result in a variable dose. Examples of suitable propellants includehydrofluoroalkane propellants, such as 1,1,1,2-tetrafluoroethane(CF3CH2F) (HFA-134a) and 1,1,1,2,3,3,3-heptafluoro-n-propane (CF3CHFCF3)(HFA-227), perfluoroethane, monochloroifluoromethane, 1,1difluoroethane, and combinations thereof.

Therapeutic Methods

A first aspect of the application provides a method for preventing ortreating a pulmonary disease or condition in a subject comprisingadministering to the subject a therapeutically effective amount of anantibody that inhibits activation of the complement cascade. In certainembodiments, an additional active agent is also administered to the samesubject. Administration of the antibody and the additional active agentmay occur simultaneously or sequentially in either order.

The term “preventing” is art-recognized, and when used in relation to acondition, such as a local recurrence (e.g., pain), a disease such ascancer, a syndrome complex such as heart failure or any other medicalcondition, is well understood in the art, and includes administration ofa composition which reduces the frequency of, or delays the onset of,symptoms of a medical condition (e.g., asthma) in a subject relative toa subject which does not receive the composition. Thus, prevention ofcancer includes, for example, reducing the number of detectablecancerous growths in a population of patients receiving a prophylactictreatment relative to an untreated control population, and/or delayingthe appearance of detectable cancerous growths in a treated populationversus an untreated control population, e.g., by a statistically and/orclinically significant amount. Prevention of an infection includes, forexample, reducing the number of diagnoses of the infection in a treatedpopulation versus an untreated control population, and/or delaying theonset of symptoms of the infection in a treated population versus anuntreated control population. Prevention of pain includes, for example,reducing the magnitude of, or alternatively delaying, pain sensationsexperienced by subjects in a treated population versus an untreatedcontrol population.

The term “treating” includes prophylactic and/or therapeutic treatments.The term “prophylactic or therapeutic” treatment is art-recognized andincludes administration to the host of one or more of the subjectcompositions. If it is administered prior to clinical manifestation ofthe unwanted condition (e.g., disease or other unwanted state of thehost animal) then the treatment is prophylactic, (i.e., it protects thehost against developing the unwanted condition), whereas if it isadministered after manifestation of the unwanted condition, thetreatment is therapeutic, (i.e., it is intended to diminish, ameliorate,or stabilize the existing unwanted condition or side effects thereof).

Pulmonary diseases or conditions contemplated by the applicationinclude, but are not limited to, asthma, bronchial constriction,bronchitis, a chronic obstructive pulmonary disease (COPD), interstitiallung diseases, lung malignancies, α-1 anti-trypsin deficiency,emphysema, bronchiectasis, bronchiolitis obliterans, sarcoidosis,pulmonary fibrosis, and collagen vascular disorders.

The subject or patient receiving this treatment is any animal in need,including primates, in particular humans, and other mammals such asequines, cattle, swine and sheep, and poultry and pets in general.

The phrase “therapeutically effective amount” as used herein means thatamount of a compound, material, or composition comprising a compound ofthe present invention which is effective for producing some desiredtherapeutic effect by inhibiting C5 or activation of the complementcascade in at least a sub-population of cells or an organ in an animaland thereby blocking the biological consequences of that function in thetreated cells or an organ, at a reasonable benefit/risk ratio applicableto any medical treatment.

The timing of administering a therapeutic to a subject can vary, forexample, depending on the identity of the subject or the pulmonarydisease or condition to be treated or prevented, or both. For example,the administration may occur before the manifestation of the pulmonarycondition (e.g., pre-asthmatic attack or pre-bronchial constriction),during the manifestation of the pulmonary condition (e.g., during theasthmatic attack or bronchial constriction), or after the manifestationof the pulmonary condition (e.g., post-asthmatic attack orpost-bronchial constriction).

The phrase “inhibits the activation of complement cascade” refers to anyinhibitory effect or action on any component of the complement system asdescribed above conferred by an antibody or active agent of the presentapplication. The inhibitory effect may be manifested by decrease in orlack of a response typical to activation of complement. For example,typical cellular and other biological responses to activation ofcomplement include, but are not limited to, release of histamine, smoothmuscle contraction, increased vascular permeability, leukocyteactivation, chemotaxis (e.g., movement of granulocytes to the site ofcomplement activation), and other inflammatory phenomena includingcellular proliferation. In certain embodiments, the inhibitory effect isspecific to the C5 component. In certain embodiments, the inhibitoryeffect is specific to C5 convertase, for example, blocking C5convertase's function to convert C5 into C5a and C5b-9. In certainembodiments, the inhibitory effect is specific to C5a. In certainembodiments, the inhibitory effect is specific to C5b or C5b-9.

EXAMPLES

The following examples are offered by way of illustration and not by wayof limitation.

Materials and Methods

Animals: Male C5s BALB/cByJ, C57BL/6J mice and C5d B10D2oSn/J, AKR/J andSWR/J mice were purchased from the Jackson Laboratory and housed in apathogen free facility. In addition to serum C5b-9 mediated hemolysis,the C5 genotype was further confirmed by PCR performed on tail DNA usinga pair of primers (5′-CAC GAT AAT GGG AGT CAT CTG GG-3′ (SEQ ID NO:1)and 5′-AAG TTG GAG TGT GGT CTT TGG GCC-3′ (SEQ ID NO:2) that amplify a280-bp DNA fragment from both C5s and C5d DNA. This fragment encodes aHindIII site that is selectively destroyed by a mutation in the C5 gene,such that HindIII (New England BioLabs, MA) digestion selectivelycleaves the C5s but not the C5d PCR products into 150 and 130-bpfragments. All animal protocols were reviewed by Institutional Committeeand were in accordance with NIH guidelines.

Reagents: Anti-mouse C5 mAb (BB5.1) (Wang et al., Proc. Natl. Acad. Sci.U.S.A (1996) 93:8563-8568) and an isotype matched irrelevant control mAb(HFN7.1), which is specific to human fibronectin, were purified fromascites. BB5.1 Fab, which was purified with a kit (PierceBiotechnology), had retained similar activity of BB5.1 and was more than97% in purity. The anti-C5aR sIgG, which was shown to prevent mortalityin experimental sepsis (Riedemann et al., J. Clin. Invest. (2002)110:101-108), was able to prevent zymosan induced neutrophil migration.Both anti-C5aR sIgG and the control sIgG were purified from seraharvested from C5aR deficient mice (Gerard et al., Curr. Opin. Immunol.(2002) 14:705-708) that were repeatedly immunized with either PBS orpeptide spanning the N-terminus of the mouse C5aR and one extra cysteine(Riedemann et al., supra) emulsified with CFA. Antibodies from eitherascites or serum samples were purified by protein A affinitychromatography (Amersham). Corticosteroid (dexamethasone) was purchasedfrom Sigma. Recombinant mouse C5a, which was free of endotoxincontamination and had potent chemotactic activity in neutrophilmigration assay, was cloned and purified as previously reported(Riedemann et al., supra).

Induction of Airway Inflammation and Severe Airway Response

BALB/c and B10D2oSn Mice 10-12 wks of age were sensitized on day 1 andday 14 with i.p. injection of 20 μg OVA (Grade V; Sigma) emulsified in 2mg aluminum hydroxide (Alum Inject; Pierce Biotechnology). Mice wereimmunized with 1% OVA for 10 min via airway on days 28, 29 and 30 with ajet nebulizer (Harvard Apparatus) connected to a single housing chamber(Buxco Electronics, Inc.). On day 32, all sensitized animals wereaerosol challenged with 5% OVA for 10 min. In checkpoint 3 experiments,BALB/c mice were aerosol challenged with 5% OVA again on day 35. ShamC5s or C5d mice were immunized with Alum only and aerosol challengedwith PBS instead of OVA.

Non-Invasive Measurement of sRaw

sRaw, which measures the resistance of both upper and lower airways, wasmeasured by a DCP in conscious animals with spontaneous breathing(Buxco). The DCP was used to monitor the longitudinal changes of sRawprior to and after each 5% OVA aerosol challenge. In checkpoint 3experiments, a DCP was used to ensure the appearance of EAR prior torandomizing animals into different treatment groups.

Invasive Measurement of Lower Airway Functions

Changes in RL and Cdyn were measured by using Buxco Biosystem softwareand a Buxco whole body plethysmograph. Mice were anesthetized (Avertin,160 mg/kg) and tracheas cannulated. Spontaneous breathing was blocked bypancuronium bromide (0.3 mg/kg i.p.). Respirations were maintained by aHarvard Apparatus Inspira ventilator, which calculated a tidal volumeand respiratory rate according to body weight. Measurements of RL andCdyn were performed during the peak of LAR, 5 h after aerosol challengewith 5% OVA. Real-time changes of RL and Cdyn were recorded by Buxcosoftware and reported as the mean value of five min of recording. AHRwas evaluated based on changes of RL and Cdyn during aerosol Mchchallenges. Changes in RL and Cdyn were expressed as a percentage ofbaseline after each aerosol challenge. A Buxco aerosol control andsonicating nebulizer unit was attached to the ventilator for aerosoldelivery of Mch through tracheal cannulation. PBS or Mch (1.6 mg/ml) wasdelivered at the rate of 10 puffs or 20 puffs per 10 seconds, with eachpuff of aerosol delivery lasting 15 ms.

C5 Inhibition

(1) For C5 inhibition at checkpoint 1, anti-C5 mAb (BB5.1) or a controlmAb (HFN7.1) was administered i.p. at 40 mg/kg on days 25, 29, and 31.Dexamethasone (2 mg/kg) was used as a positive control. (2) Animals thatexperienced airway response to 5% OVA provocation on day 32 wererandomized for the following studies. For C5 inhibition at checkpoint 2,animals were given one i.p. injection of either dexamethasone (2 mg/kg),anti-C5 mAb (40 mg/ml) or control mAb (40 mg/kg) on day 33. On day 35,animals were anesthetized and tracheas cannulated for measurement of RLand Cdyn during aerosol Mch challenges. (3) At checkpoint 3, anti-C5 mAb(40 mg/kg), control mAb (40 mg/kg), or dexamethasone (2 mg/kg) wasadministered by i.v. injection 20 min after aerosol challenging animalswith 5% OVA on day 35. For intrapulmonary C5 inhibition at this criticalpoint, animals were given aerosol administration of either anti-C5 mAb(3 mg/ml), anti-C5 Fab (3 mg/ml), control mAb (3 mg/ml), anti-C5aR sIgG(3 mg/ml), control sIgG (2 mg/ml), or corticosteroid (2 mg/ml) for 10-30min by using a jet nebulizer connected to a single chamber housing theanimal. Sham-immunized mice were given sham treatment with the samevolume of PBS solution administered through the same route. The resultsfrom three intrapulmonary C5 inhibition experiments, which wereconducted with identical protocols, were pooled together.

Analysis of Bronchoalveolar Lavage Fluid (BALF)

Approximately 5.5 h after allergen provocation, after the measurement ofRL and Cdyn, BALF was harvested by instilling 1 ml PBS through thetracheal cannula, followed by gentle aspiration. The BALF wasresuspended in 400 μl PBS. The total numbers of WBC in BALF were countedby using a hemocytometer or an automatic cell counter as in the aerosolexperiments (Cell-Dyn 3700 Abbott). Cytospin slides were prepared, fixedand stained using Diff-Quik (VWR International, Inc.). The WBCdifferential was determined by a certified pathologist after counting atotal of 300 WBC per slide on a 100× microscopic lens. The BALF levelsof proMMP9, activated TGF-β, RANTES, eotaxin and IL-13 (R&D Systems,Inc.), IL-5 (Amersham Pharmacia Biotech, Inc.), and histamine(Immunotech, Inc.) were measured by ELISA according to themanufacturer's instructions.

Analysis of Serum OVA Specific Antibodies

Serum samples were harvested 5 h after 5% allergen provocation on day 32for OVA specific IgG and IgE by ELISA.

Lung Histology

Lung was inflated with 10% buffered formalin (1 ml) through trachealcannulation and fixed in 10% formalin at least 24 h. Lung samples werestained with Giemsa. Double blind histological analysis was performed toquantify airway inflammation according to the following criteria. 0: Nodetectable airway inflammation; 1: Less than 25% bronchials andsurrounding vasculature were found with either perivascular orperibronchial inflammatory cell infiltration; 2: Approximately 25-50% ofbronchials and surrounding vasculature were affected; 3: Approximately50-75% bronchials and surrounding vasculature were affected; 4: >75% ofbronchials and surrounding vasculature were affected.

C5b-9 Mediated Hemolytic Assay and in Vitro C5a Mediated NeutrophilMigration Assay

Serum harvested at the indicated time was used as the source of C5b-9,which mediated the hemolysis of chicken RBC as previously reported (Wanget al., supra). Mouse sera (Sigma) were incubated with either BB5.1 (100μg/ml) or the same volume of PBS prior to activation with zymosan (1mg/ml; Sigma). Diluted sera (20%) were used as the source of C5a forneutrophil chemotaxis experiments.

Statistical Analysis

The data were expressed as the means±S.E.M. Student's one-tailed t-testassuming equal variance was used (MS Windows). A P value less than 0.05was considered significant.

Blocking the Generation of C5a and C5b-9 by Anti-C5 mAb, BB5.1

Functional inhibition of complement component C5 by anti-C5 mAb wasdetermined by the pharmacodynamic profile of blocking serum C5b-9mediated hemolytic activity (FIG. 1 A). In addition, C5a mediatedneutrophil migration was determined in an in vitro assay (FIG. 1 B). Thepharmacodynamics of C5 inhibition by a single i.v. injection of anti-C5mAb, BB5.1, is very different from the pharmacodynamics of a single i.p.injection during the first 5 h after administration. More than 80% ofC5b-9 mediated hemolysis was inhibited within 1 h of i.v. administrationof BB5.1, compared to less than 30% of inhibition by i.p. injection.Administration of anti-C5 m-Ab continued blocking more than 60% ofhemolysis between 5 h and 48 h after i.v. injection while approximately56% of hemolysis was blocked during this period of time after i.p.injection. Serum samples harvested from control mAb treated mice hadmore than 80% of normal hemolytic activity during the entire period ofthe study (FIG. 1 A). Hemolytic activity gradually returned to thenormal range one wk after a single injection of anti-C5 mAb.

An in vitro neutrophil migration assay was employed to test the abilityof anti-C5 mAb on blocking the generation of C5a (FIG. 1 B). Inhibitionof serum samples with anti-C5 mAb prior to zymosan activationsignificantly blocked human neutrophil chemotaxis which was mediated bythe presence of C5a after zymosan activation, as seen in zymosanactivated control sera (FIG. 1, B). Since anti-C5 mAb, BB5.1, blockedthe generation of both C5a and C5b-9 and did not bind to C5a directly,this anti-C5 mAb is probably specific to blocking cleavage of C5 by C5convertase.

Development of Severe Airway Response in OVA Sensitized Animals andDefinition of Three Critical Points

OVA-sensitized animals immediately developed a severe airway responseafter aerosol challenge with 5% OVA (FIG. 2 A). A typical airwayresponse to aerosol provocation with allergen consisted of anearly-phase airway response (EAR), which is known to be mediated by therelease of histamine by mast cells, and a late-phase airway response(LAR), which is mediated by the combination of effects of infiltrationof inflammatory cells, edema and bronchial constriction (Larsen, Annu.Rev. Immunol. (1985) 3:59-85). The airway response after 5% OVAprovocation was monitored by a non-invasive double chamberplethysmograph (DCP) in each mouse to measure the longitudinal changesof specific airway response (sRaw), which indicates the appearance ofEAR and LAR (FIG. 2 A). EAR was typically a brief elevation of sRaw 15min after 5% OVA provocation and LAR was typically observed 5 h later,consistent with an earlier report (Cieslewicz et al., J. Clin. Invest.(1999)104:301-308). Both EAR and LAR have magnitudes between 5 to 30fold over the baseline. The severe airway response during the peak ofLAR was generally evident as animals showed obvious labored breathing.Since inhibition of C5 can be achieved by the administration of anti-C5mAb, we sought to dissect the critical involvement of C5 and itsactivated components at three critical points (FIG. 2 B) during criticalstages of the disease. The three critical checkpoints are: 1) initiationof airway inflammation, one of the two hallmarks of asthma'spathogenesis; 2) development of AHR to nonspecific stimuli, anotherhallmark of asthma; and 3) sustainment of an on-going airway responseafter allergen provocation. Both checkpoint 2 and checkpoint 3 aredesigned to evaluate the contribution of C5 in subjects that hadexperienced severe airway response previously (FIG. 2 B) and hadestablished airway inflammation. Checkpoint 3 studies were conductedduring an on-going airway response after allergen provocation byadministering treatment via either an i.v. or aerosol route during theEAR. Functions of lower airways and quantification of airwayinflammation were evaluated during the peak of LAR, 5 h after 5% OVAprovocation.

Checkpoint 1: Involvement of C5 in the Initiation of Airway Inflammation

C5 inhibition at checkpoint 1, at the time of repeat aerosolsensitization of 1% OVA, had no significant impact on serum levels ofOVA-specific IgE or IgG on day 32 (FIG. 3 A). Corticosteroid treatedmice also had elevated levels of OVA-specific IgE and IgG, that may havebeen generated long before the corticosteroid or anti-C5 mAb wasadministered on day 25. Sham treated mice had a negligible level of OVAspecific IgG or IgE. As a result of repeated administration (i.p.) ofanti-C5 mAb, approximately 80% of C5b-9 mediated hemolysis was inhibitedon day 32 (21.1%±4) as compared to the normal hemolytic activity seen incontrol mAb and corticosteroid treated mice (92.70%±6.8). Two keyfunctions of lower airways were examined by tracheal cannulation at 5 hafter 5% OVA provocation. The increase in lung resistance (RL) iscommonly associated with significant obstruction of lower airways (FIG.3 B) and a decrease in the dynamic lung compliance (Cdyn) is associatedwith the loss of lung elasticity, an important characteristic of thereturn to normal volume after pressure changes seen in a normal lung(FIG. 3 C). The significantly increased RL and reduced Cdyn seen incontrol mAb-treated mice indicated an increased airway obstruction(FIGS. 3 B and C). Sham-mice provided normal ranges of RL and Cdyn at 5h after exposure to aerosol PBS solution.

Correlating to its potent anti-inflammatory and anti-asthmaticactivities, corticosteroid treatment at checkpoint 1 significantlyblocked the increase of RL and prevented the loss of Cdyn. Similarly, C5inhibition at checkpoint 1 markedly reduced the increase of RL 5 h afterallergen provocation with an RL of 1.66 cm H₂O/ml/second±0.2, comparedto an RL of 2.17 cm H₂O/ml/second±0.33 seen in control mAb treatedanimals (FIG. 3 B). C5 inhibition also slightly reduced the loss of Cdyn(FIG. 3 C). Double blind histological analysis (FIG. 3 D) of lung tissueconfirmed data from the function analysis and demonstrated that controlmAb-treated BALB/c mice had severe perivascular and peribronchialinfiltration of inflammatory cells (FIG. 3 F). A significant reductionof histology score was observed in corticosteroid treated mice (FIG. 3G) while less impressive reduction was observed in anti-C5 mAb-treatedmice (FIG. 3 H). Similar to severe allergic asthma in humans,eosinophils were the predominant inflammatory cells (more than 50%) inthe perivascular and peribronchial lesions along the airways (FIGS. 3F-H).

Checkpoint 2: Contribution of C5 in the Development of AHR in Animalswith Established Airway Inflammation

In addition to airway inflammation, AHR to non-specific stimuli isanother hallmark of asthma. AHR was evaluated as changes of RL and Cdynexpressed as a percentage of baseline in response to increasing doses ofaerosol methacholine (Mch) challenges (FIGS. 4 A and B). ControlmAb-treated BALB/c mice had significant increases of RL and significantlosses of Cdyn during the course of aerosol Mch challenges, whilesham-mice responded only modestly to aerosol Mch challenges. Two ofeight among control mAb-treated mice died during high doses of aerosolMch challenge due to severe respiratory stress. In contrast, C5inhibition prevented dramatic increases of RL and the reduction of Cdynduring the course of aerosol Mch challenges, similar to those animalstreated with corticosteroid (FIGS. 4 A and B). The loss of Cdyn andincrease of RL during the course of aerosol Mch challenges compared tosham-mice were probably due to the presence of established airwayinflammation in these animals. There were no noticeable differences inthe degree of airway inflammation among the three treated cohorts.Anti-C5 mAb treated mice had approximately 45% of normal hemolyticactivity on day 35.

In order to compare our results of C5 inhibition at checkpoint 2 withdata from a previous report (Karp et al., Nat. Immunol. (2000)1:221-226), the presence or absence of native intrinsic AHR was examinedin some strains of normal C5d mice as previously reported (De Sanctis etal., Am. J. Respir. Crit. Care Med. (1997) 156:S82-S88; Levitt et al.,FASEB J. (1998) 2:2605-2608). Non-immunized C5d AKR/J mice have dramaticairway responses to increasing doses of aerosol Mch challenges withsignificant increases of RL over baseline (84.2%±16.7 with 20 puffs Mch)and a significant reduction of Cdyn under baseline (40%+5.4 with 20puffs of Mch) whereas C5d SWR/J and BIOD2oSn mice have minimal changesof RL and Cdyn, indistinguishable from C5 sufficient (C5s) BALB/c miceand C57BL/6 mice, with no more than a maximal change of 15% of either RLor Cdyn away from baseline (n=3 for each strain, data not shown). Next,C5d BIOD2oSn mice, which do not have intrinsic AHR, were immunized andchallenged with aerosol Mch in the identical manner as C5s BALB/c micein FIGS. 4 A and B. Subgroups of sensitized C5d animals were also giveneither control or anti-C5 mAb treatment on day 33. C5d B10D2oSn micedeveloped a similar degree of airway inflammation as C5s mice, with anaverage histology score of 1.91±0.37 (n=6) compared to a histology scoreof 2.25±0.25 in C5s BALB/c mice (n=4). No noticeable histologicaldifference was observed between anti-C5 mAb and control mAb treated C5dmice. In contrast to a previous report (Karp et al., supra), increasingdoses of aerosol Mch challenges did not induce significant changes oflower airway functions in OVA immunized B10D2oSn mice (FIGS. 4 C and D).Treatment with either anti-C5 mAb or control mAb on day 33 had no impacton the development of AHR. The data from both mAb treated cohorts werepooled together as an mAb treated cohort (FIGS. 4 C and D). Furthermore,reconstitution of OVA immunized B10D2.oSn mice with recombinant mouseC5a (rmC5a) completely restored AHR in response to aerosol Mch challengeas indicated by the significant increase of RL and reduction of Cdyn(FIGS. 4 C and D).

Reconstitution of rmC5a was not sufficient for the development of AHRsince sham-B10D2.oSn mice reconstituted with rmC5a did not havesignificant changes of lower airway functions during Mch challenge(FIGS. 4 C and D). Analysis of serum samples harvested from each mouseafter Mch challenges confirmed the C5 deficient status of B10D2.oSn micewith average hemolytic activity of 8.1%±0.9 compared to 108%±/3.8 of C5sBALB/c mice. Furthermore, random tail samples (n=2) from each lot of C5sand C5d animals were analyzed to confirm the C5 genotype status.

Checkpoint 3: Contribution of C5 During an On-Going Airway Response

The role of C5 in sustaining an on-going airway response was alsoexamined. Intervention was given during the peak of EAR, which wasmonitored by DCP at 15 min after aerosol exposure to 5% OVA on day 35.All control mAb-treated BALB/c mice developed severe LAR withsignificant increases of RL and reductions of Cdyn 5 h after allergenprovocation (FIGS. 5 A and B).

Administration of treatment through i.v. injection during EAR wasselected to achieve rapid systemic C5 inhibition, which completelyblocked the development of LAR with minimal increase of RL 5 h after 5%OVA provocation (FIG. 5 A) and prevented much of the loss of lungelasticity indicated by the minimal reduction of Cdyn (FIG. 5 B).Interestingly, corticosteroid treatment did not eliminate thedevelopment of LAR with significant elevation of RL and reduction ofCdyn at 5 h.

Although no immediate impacts (within 5 h) on lower airway functionswere observed after i.v. corticosteroid treatment (FIG. 5 A), thistreatment significantly modulated the intrapulmonary IL-13 (FIG. 7 B)and significantly improved lower airway functions 24 h later. Doubleblind histologic analysis of lung tissue showed comparable levels ofperivascular and peribronchial infiltration of inflammatory cells fromthe animals 5 h after i.v. intervention with either corticosteroid,anti-C5 mAb or control mAb, similar to the histological sample shown inFIG. 3 F.

Effect of C5 Inhibition on the Migration of Inflammatory Cells

The migration of inflammatory cells from airway tissue inflammation intobronchial lumen as enumerated was also examined by bronchial alveolarlavage fluid (BALF) WBC analysis. There was a significant reduction oftotal BALF inflammatory cells in anti-C5 mAb-treated BALB/c micecompared to control mAb-treated mice at checkpoint 1 (FIG. 6 A). Theblockade on the migration of inflammatory cells by C5 inhibitionexceeded the degree of improved lower airway function (FIGS. 3 B and C)and reduced tissue inflammation (FIG. 3 D). Similarly, when BALF washarvested at checkpoint 3 (FIG. 6 B), C5 inhibition again hadsignificant blockade on the migration of inflammatory cells intobronchial lumen, with significantly lower BALF WBC counts in anti-C5treated animals than in animals treated with either corticosteroid orcontrol mAb. This result is in dramatic contrast to the prominentpresence of perivascular and peribronchial infiltration of inflammatorycells in lung tissue harvested before allergen provocation on day 35.The significant blockade on the migration of inflammatory cells by C5inhibition correlated with the significantly enhanced efficacy of C5inhibition over corticosteroid therapy at checkpoint 3 (FIGS. 5 A andB).

Sham mice provided the baseline level of BALF WBC counts, which areprimarily normal alveolar macrophages (82.3%±10.3) in WBC differentialanalysis (FIG. 6 C). Eosinophils constituted more than 45% of BALFinflammatory cells from all OVA immunized animals, regardless of thetherapeutic intervention. There was a significant reduction in thepercentage of neutrophils recovered in BALF from the animals treated atcheckpoint 3 with either corticosteroid (4.5%±2.8) or anti-C5 mAb(6.3%±3.3) versus control mAb treated mice (18.3%±4.4). No significantreductions occurred in the percentages of eosinophils or lymphocytes inBALF samples from the animals given intervention at checkpoint 3 (FIG. 6C).

Effect of C5 Inhibition on Intrapulmonary Th1/Th2 Cytokine Profile andInflammatory Mediators

BALF harvested from control mAb treated mice had markedly increasedlevels of IL-5 and IL-13 (FIGS. 7 A and B) as compared to sham mice.Corticosteroid treatment markedly reduced the BALF levels of IL-5 andIL-13, however, this did not translate into an immediate improvement oflower airway function (FIGS. 5 A and B) during the 5 h period oftreatment. The dramatic improvement of lower airway functions (FIGS. 5 Aand B) seen after C5 inhibition at checkpoint 3 did not correlate withany reduction of BALF level of IL-5 and IL-13. The statisticaldifference of the BALF level of IL-13 between anti-C5- andcorticosteroid-treated mice equals a p value of 0.051 C5 inhibition orcorticosteroid therapy at checkpoint 3 did not influence the BALF levelof histamine (FIG. 7 C). This was expected since histamine had probablyalready been released into the airway lumen upon the engagement of IgEreceptors of mast cells by aerosol allergen provocation and wasresponsible for the appearance of EAR when therapeutic intervention wasgiven. Eosinophils, the most prominent inflammatory cells along lowerairways (FIGS. 3 F-H), are probably responsible for the production ofeotaxin, RANTES and TGF-β (FIGS. 7 D-F) in asthmatic individuals.Control mAb-treated animals had significantly elevated BALF levels ofeotaxin (FIG. 7 D), RANTES (FIG. 7 E), or activated TGF-β (FIG. 7 F),compared to negligible or non-detectable levels of these mediators insham-mice. In contrast, C5 inhibition had a marked impact on BALF levelsof eotaxin, RANTES, and activated TGF-0 when given either at checkpoint1 (Figs., D and E) or checkpoint 3 (FIG. 7 F). Corticosteroid treatmentonly reduced the BALF level of TGF-β when given at checkpoint 3 but hadno obvious impact on the production and release of eotaxin or RANTESwhen given at checkpoint 1.

Neutrophils are commonly believed to be responsible for the productionof bronchial TNF-α and proMMP9. C5 inhibition significantly reduced BALFlevels of TNF-α (FIG. 7 G) when given at checkpoint 1, significantlydifferent from control mAb-treated mice. The bronchial level of proMMP9was dramatically reduced and was significantly different from controlmAb-treated and corticosteroid-treated mice when C5 inhibition was givenat checkpoint 3 (FIG. 7 H).

Checkpoint 3: Contribution of Intrapulmonary Activation Of C5 During anOn-Going Airway Response

The massive migration of inflammatory cells from airway tissueinflammation into bronchial lumen probably results from powerfulchemotactic forces from the epithelial mucosa of the airway. Thus, C5may be activated intrapulmonarily during an airway response to allergenprovocation. The functions of lower airways and parameters ofinflammation were evaluated after blocking the intrapulmonary activationof C5. The potential impact at checkpoint 3 by inhibitory receptors,such as FcγRIIB (Katz, Curr. Opin. Immunol. (2002) 14:698-704; Ravetchet al., Annu. Rev. Immunol. (2001) 19:275-90), were also evaluated, asthe result of interaction between intrapulmonary C5 and anti-C5 mAb andthe subsequent formation of immune complexes (IC).

Effect of intrapulmonary C5 inhibition with anti-C5 mAb was directlycompared to anti-C5 Fab in order to achieve this goal. Furthermore, theefficacy of an anti-C5aR serum IgG (sIgG) was evaluated in order todissect the role of intrapulmonary C5a versus C5b-9 at this checkpoint.As demonstrated in FIGS. 8 A and B, control mAb-treated animalsdeveloped severe LAR with significant increases of RL and significantreductions of Cdyn, in significant contrast to the normal RL and Cdynseen in sham-mice. Aerosol administration of corticosteroid blocked thedevelopment of LAR as evidenced by the reduction of RL withcorresponding preservation of Cdyn. Blocking intrapulmonary C5activation with aerosol administration of either anti-C5 mAb or anti-C5Fab during the peak of EAR also prevented the development of LAR withminimal increase of RL and minimal reduction of Cdyn (FIGS. 8 A and B).RL and Cdyn of both anti-C5 treated cohorts were significantly differentfrom control mAb treated animals. Blocking the binding of intrapulmonaryC5a to its receptors with an anti-C5aR sIgG also prevented thedevelopment of LAR with minimal increase of RL and minimal reduction ofCdyn similar to animals treated with anti-C5 mAb. There was nostatistical difference between the three cohorts treated with eitheranti-C5 mAb, anti-C5 Fab, or anti-C5aR sIgG (FIGS. 8 A and B).

When the parameters of intrapulmonary inflammatory activities wereexamined, such as the migration of inflammatory cells (FIG. 8 C) and theBALF level of proMMP9 (FIG. 8 D), significant differences were foundbetween blocking intrapulmonary activation of C5 versus blocking thebinding of C5a to its C5aR. Aerosol administration of either anti-C5 mAbor its Fab fragment during EAR significantly blocked both the migrationof inflammatory cells into bronchial airway lumen and the elevation ofBALF level of proMMP9, whereas blocking the engagement of C5aR had nosignificant impact on these two key inflammatory parameters similar tothe animals treated with control mAb (FIGS. 8 C and D). Consistent withits ability to block the development of LAR (FIGS. 8 A and B), aerosoladministration of corticosteroid also ameliorated intrapulmonaryinflammatory activities with marked reduction of the migration ofinflammatory cells and the production of proMMP9 (FIGS. 8 C and D)indicating the importance of inflammatory activities at the epithelialside of the bronchial lumen. Aerosol administration of anti-C5 mAb,anti-C5 Fab or anti-C5aR sIgG did not have any impact on serum C5b-9mediated hemolytic activity.

Combination Therapy:

As demonstrated in FIG. 9, animals treated with a non-specific controlantibody had significant increases of lung resistance during the courseof Mch challenges. In this study, two animals challenged with high dosesof Mch died due to severe respiratory stress. In contrast, both thesteroid and anti-C5 treated animals have only moderate increases of lungresistance, higher than normal sham immunized animals but significantlylower than control placebo treated mice. Combined treatment with bothanti-C5 antibody and steroid significantly further reduced the increasesof lung resistance during the course of Mch challenges. Based on thisresult, both steroid and C5 inhibitor can prevent the development ofairway hyper-responsiveness to non-specific aerosol stimuli in asthmaticindividuals with established airway inflammation.

Nebulization Formulations

Examples of formulations suitable for nebulization of an antibody areshown in FIG. 10. FIG. 11 further demonstrates the effectiveness ofnebulization treatment. The results shown in FIG. 11 were obtainedfollowing a study that employed the same protocol as the Checkpoint 2study described herein, except that the treatment here was delivered bynebulization on day 32 instead of i.p. For anti-C5 antibody, 3 mg/ml ofBB5.1 was subject to 10 min nebulization, and 2 mg/ml steroid was alsosubject to 10 min nebulization. For the combination therapy, the finalconcentrations subjected to 10 min nebulization were: 3 mg/ml for BB5.1and 2 mg/ml for the steroid.

FIG. 12 further shows that eculizumab in Formulation 1 (FIG. 10) at 30mg/ml can be effectively and efficiently nebulized by a conventionalnebulizer such as the Pari LC Jet Plus or a specialty nebulizer such asSonik LDI. FIG. 12 shows that a majority of the particles afternebulization were less than 5 μM, which is suitable for deep lungdelivery.

As shown in FIG. 13, eculizumab in Formulation 1 (FIG. 10) can beeffectively and efficiently delivered by a conventional nebulizer,comparable to the aerosol characteristics of an existing pulmonary drugdelivered by inhalation, Pulmozyme®, also using a conventionalnebulizer. Eculizumab in Formulation 1 (FIG. 10) can also be effectivelyand efficiently delivered by a specialty nebulizer, for example, SonikLDI.

Using SDS-PAGE and HPLC analyses, FIG. 14 and FIG. 15 demonstrate thateculizumab can be effectively and efficiently delivered by nebulization.Eculizumab in a suitable formulation was nebulized using either thePari-Jet Air nebulizer or the Sonik LDI nebulizer. The nebulizedantibody, in a spray form, was collected from the mouth piece of thenebulizer (e.g., F1D2F), and different sizes of mouth pieces (e.g.,F1D2C1-C5) were used. The SDS-PAGE and HPLC analyses demonstrated theintegrity of the nebulized antibody through various sizes of the spraymouth piece, as shown by the purity of the samples analyzed.

REFERENCES

All publications and patents mentioned herein, are hereby incorporatedby reference in their entirety as if each individual publication orpatent was specifically and individually indicated to be incorporated byreference.

Equivalents

Those skilled in the art will recognize, or be able to ascertain usingno more than routine experimentation, many equivalents to the specificembodiments of the application described herein. Such equivalents areintended to be encompassed by the following claims.

1. A method for preventing or treating a pulmonary condition in asubject comprising administering to the subject a therapeuticallyeffective amount of an antibody that inhibits activation of thecomplement cascade and an additional active agent.
 2. The method ofclaim 1, wherein the pulmonary condition is selected from the groupconsisting of: asthma, bronchitis, a chronic obstructive pulmonarydisease (COPD) interstitial lung diseases, lung malignancies, α-1anti-trypsin deficiency, emphysema, bronchiectasis, bronchiolitisobliterans, sarcoidosis, pulmonary fibrosis, and collagen vasculardisorders.
 3. The method of claim 1, wherein the subject is a human. 4.The method of claim 1, wherein the antibody is specific to C5.
 5. Themethod of claim 1, wherein the antibody is specific to C5 convertase. 6.The method of claim 1, wherein the antibody is specific to C5a or C5b-9.7. The method of claim 1, wherein the antibody is eculizumab orpexelizumab.
 8. The method of claim 1, wherein the antibody is selectedfrom the group consisting of: a full length immunoglobulin, a singlechain antibody, a domain antibody, a Fab fragment, and an antibodyhaving a Fab fragment and a mutated Fc portion.
 9. The method of claim7, wherein the mutated Fc portion does not activate complement.
 10. Themethod of claim 1, wherein the antibody is administered prior tomanifestation of the pulmonary condition, during manifestation of thepulmonary condition, or after manifestation of the pulmonary condition.11. The method of claim 1, wherein the additional active agent is acorticosteroid.
 12. The method of claim 1, wherein the corticosteroid isdexamethasone.
 13. The method of claim 1, wherein the antibody and theadditional active agent may be administered to the subject by the samedelivery method or route.
 14. The method of claim 1, wherein theantibody and the additional active agent may be administered to thesubject by different delivery methods or routes.
 15. An aerosolcomposition comprising an antibody that inhibits activation of thecomplement cascade, wherein the composition is suitable for preventingor treating a pulmonary condition in a subject.
 16. The aerosolcomposition of claim 15, wherein the antibody is formulated in acomposition suitable for aerosolization.
 17. The aerosol composition ofclaim 15 further comprising an additional active agent.
 18. Abiopharmaceutical package comprising: a) an antibody that inhibitsactivation of the complement cascade; and b) a nebulizer, wherein thepackage is suitable for preventing or treating a pulmonary condition ina subject.
 19. The biopharmaceutical package of claim 18, wherein thenebulizer is selected from the group consisting of a jet air nebulizer,an ultrasonic nebulizer, a vibrating mesh nebulizer and a shockwavenebulizer.
 20. The biopharmaceutical package of claim 19 furthercomprising instructions for use.
 21. The biopharmaceutical package ofclaim 19 further comprising an additional active agent.
 22. A pulmonarydrug delivery kit comprising: a) an inhaler; and b) an antibodyformulated for inhalation delivery.
 23. The kit of claim 22, whereinsaid inhaler is a metered dose inhaler.
 24. The kit of claim 23, whereonthe metered dose inhaler is a pressurized metered dose inhaler.
 25. Thekit of any one of claims 22 or 23, wherein said inhaler furthercomprises a holding chamber.
 26. The kit of claim 22, wherein saidinhaler is a nebulizer.
 27. The kit of claim 26, wherein said nebulizeris an ultrasonic nebulizer.
 28. The kit of claim 26, wherein saidnebulizer is a jet air nebulizer.
 29. The kit of claim 22, wherein saidinhaler is a dry powder inhaler.
 30. A pulmonary drug delivery kitcomprising a) an anti C5 antibody composition comprising 1 mg/ml to 200mg/ml; and b) a label indicating administration by nebulization.